Infertility

When Should a Couple be Evaluated for Infertility?

Because it often takes months to achieve pregnancy, infertility is not diagnosed until achieving pregnancy has been unsuccessful for one year. However, it may be reasonable to have basic fertility evaluation from their obstetrician-gynecologist after 6 months.

Some Couples Should be Evaluated Sooner

Some couples should come in sooner for evaluation.

Age - A common reason for early evaluation is the woman's age, since fertility decreases fairly rapidly in the late 30's. Women over 35 years of age should be evaluated after 6 months of attempting pregnancy without success. There is no reason to delay fertility evaluation and treatment for a year or more when the chances of becoming pregnant continue to decrease with age.

Absent or abnormal menstrual cycles - Another common reason to seek evaluation and treatment is abnormal or absent menstrual cycles. The monthly release of an egg, called ovulation, is most likely to occur in women with regular, monthly menstrual cycles. Therefore, fertility rates are best for women who have regular, monthly menstrual periods.

Certainly, women who have no periods, or have less than one menstrual period every 40 days, should come in to be evaluated without delay. Likewise, women with menstrual cycle length <22 or >40 days should be evaluated for ovulation problems.

Medical history - Another important reason for early evaluation is if either member of the couple has any history of reproductive organ problems.

Men - This would include a history of testicular infections or surgery or any sexual function problems. A semen analysis (as discussed below) is a simple test to determine if the male side of the fertility equation is working.

Women - common reproductive organ problems are a history of a pelvic infection or surgery. Evaluation of the uterus and tubes can help determine if serious reproductive problems have resulted.

Which Doctors Evaluate Infertility?

Several types of health care providers can diagnose and treat fertility problems.

Gynecologic care provider - The best place to start is the health care provider who takes care of your routine gynecologic care. This may be a primary care provider, Ob-gyn, or a midwife. He or she will either begin the basic evaluation or refer you to someone who does these kinds of evaluations.

General obstetrician-gynecologist - Most basic fertility evaluations are performed by general obstetrician-gynecologists. Most of the routine diagnostic tests and basic treatments can be carried out without special equipment or additional training.

Reproductive endocrinologist - Many communities now have the services of a reproductive endocrinologist. This is an obstetrician-gynecologist with additional training in reproductive endocrinology and infertility. A large part of their practice is devoted to diagnosing and treating couples with infertility. They usually work in conjunction with a specialized laboratory that analyzes and prepares sperm for intra-uterine insemination (IUI) and handles the intricate process of fertilizing eggs and growing embryos for in vitro fertilization (IVF), as discussed below.

Sources:

American Society for Reproductive Medicine. Infertility: an overview, United States. 2003. Birmingham, Ala: American Society for Reproductive Medicine.

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